Psychiatric Co-Morbidity and Substance Use Disorders: Treatment in Parallel Systems or in One Integrated System?

Abstract

Psychiatric co-morbidity among substance users refers to the simultaneous presence of at least another psychiatric disorder in a person diagnosed with a substance use disorder. Co-morbid patients represent a substantial number of people in treatment and present greater disorder severity from both the clinical and social perspectives than those people diagnosed with only one type of disorder. We present an overview of the current state of the art concerning the choice of site of treatment, the kind of intervention, the length of such treatment, and future goals, aiming to establish a more effective intervention, and finally so as to further improve clinical outcomes.

Keywords :

• psychiatric co-morbidity
• dual diagnosis
• substance use
• treatment
• services

THE AUTHORS

Marta Torrens, Psychiatrist, PhD in Medicine, has been working in the drug abuse field since 1985 and currently is Director of Addiction Program in the Institute of Neuropsychiatry & Addictions of the Parc de Salut Mar in Barcelona, and Professor of Psychiatry at the Universitat Autónoma in Barcelona. Her main research interests are related to substance use disorders treatment, and psychiatric co-morbidity.

Paola C Rossi, Psychiatrist, PhD in Immunology, is currently working at the Institute of Neuropsychiatry & Addictions of the Parc de Salut Mar in Barcelona. Her main research lines are related to depression, psychiatric co-morbidity, and immune system interaction in drug abusers.

Roser Martinez-Riera, MD, Psychiatrist, is currently working at the Institute of Neuropsychiatry & Addictions of the Parc de Salut Mar in Barcelona. Her main research lines are related to psychiatric co-morbidity in drug abusers.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users –of whatever types and heterogeneities –which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments; ambulatory, within institutions, which can include controlled environments. Editor's note.

2 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.